IRQ Articles

Coding Q&A: Moderate sedation update 2

01-16-2017 12:26

By Waleska Pabon-Ramos, MD, MPH  e-IRQ exclusiveTwitter link

Coding: Q Moderate sedation (MS) still seems to be bundled into a few CPT codes. How should MS be reported when performed with these procedures?

 As of Jan. 1, 2017, the National Correct Coding Initiative (NCCI; a CMS program) has moderate sedation erroneously bundled into the procedures listed below. CMS will correct the error, but the correction (claims patch) will not go through until April 1, 2017. There are two ways to handle MS claims when performed with these procedures between Jan. 1 and April 1:
    1. Hold claim submission for 99151–99153 (MS) until April 1
    2. Submit claims for 9915199153 (MS) when submitting claims for the procedures and, if denied, appeal on or after April 1

Procedures with moderate sedation erroneously bundled:

  • 0424T                                          
  • 0425T                         
  • 0426T                         
  • 0427T                         
  • 0428T                         
  • 0429T                         
  • 0430T                         
  • 0431T                         
  • 0432T                         
  • 0433T                         
  • 0434T                         
  • 0435T                         
  • 0436T                         
  • 0459T                         
  • 0460T                         
  • 0461T                         
  • 36901                         
  • 36902                         
  • 36903                         
  • 36904                         
  • 36905                         
  • 36906                         
  • 36907                         
  • 36908                         
  • 36909                         
  • 37246                         
  • 37247                         
  • 37248                         
  • 37249                         
  • 43210                         
  • 45399                         
  • 45990                         
  • 61645

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